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FOR OFWICE USE: J a y l o `fin "S `• ------------- --------------------------- -------- -- l -------------------------�`-..--lq.-_._�.r � APPLICATION FOR SANITATION PERMIT Permit No. _-_/-�_-1.-/I l.'I.,_�.__I-t_'-_--. --.P_ L� �L .. - -- -----�- -- - � � -�--- (Complete in Duplicate) ,� (,f ---------_---------------- This Permit Ex fres 1 Year From Date Issued Date Issued .--- ---.__- / Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------- _-----_. �•---'`-----� -� ~� Owner's Name--------- � �r� � Phone(!-_ -_~-�` / Address------�./.. t - •• ----------------- ---------------------•--------------------•---------- ---------- .... - :... Contractor's Name--��=----- ---------- --------------- Phone----------------------------------- Installation -----.------------------- - Installation will serve:7 Residence part ent Ho se ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [j p/>C�Vvl Number of living units: � Number of bedrooms Number of baths -- Lot size ---------- ----------------------- -- --- - - Water Supply: Public system /Community system ❑ Private ❑ Depth to Water Tabler!`5--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ZrIH-ardpan ❑ Previous Application Made: (If yes,date----- ._-----) No ®/ New Construction: Yes P__I�o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest we€I__' sl8nce from foundation-----10-------Materia#---1 ------------------- No. ' -------------No. of compartments------------Z—,--- Size-__-., X_ -_-.---Liquid depth---------- ------- --Capacity_ - -_ Disposal field-. Distance from nearest well �9istance from foundation-___-r-,(�.____.Distance to nearest lot ane--_------ Number of lines--------------- ------. .----Length of each line-----_--_-r.; --------.Width of trench-_---- -. Type of filter material-_- --` /[Septh of filter material..--. �--..-----Total length--_._-- --2.2---0- Seepage Pit: Distance to nearest well--------------.-------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material -------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------------------------ k31 Size: Diameter--- ---------------------------------Deth---------------------------------------- ----------Liquid Capacity ------- gals. Privy: Distance from nearest well--------------------------------------- --- Distance from nearest building---____--_._______-__-------.._..--_---. ❑ Distance to nearest lot line--------- --------------------------------------------------------------------------------------------------------------•-------------------- lN� Remodeling and/or repairing {describe: -`--•------------------------------------ -------------------•-•--------------•------------------- O ---------------------------------------------------------------------•-----------------------------••--------------•-- --------- -•---- ---------------------------------------- ------------------------ ----------- ------- ------------------------- --------------------------------------------------------•------------------------------•----------------------•------------------------------------------ ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat and rules and regulations of the San Joaquin Local Health District. ws, (Signed) ---• ------ --=--'----------- -------------------------------- ------------------------------------------------------------------------------- -------Owner and/or Contractor] By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------- -------- ------------------ --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------( ......... -1` ' - ------ DATE------- = REVIEWEDBY---------------------------------------------------------- -- DATE------------------------------- ---------------------------- BUILDING PERMIT ISSUED ---- -------- — --------------- ---r----- DATE-------------- .---------------- ------------------------- Alterations and/or recommendations:------ -� y /_ — ----- `r -`: t--= ��.-----: -:-::9 :�` ----• ----------------- '' r� 2� r yc� - - •.---� - e _`-.-----..�6 -------------------------------------------------------------------- FINAL INSPECTION BY:----. ------- -- -----�JOAQUIN _--,------------- Date------------ -- - - SALOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street .205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISEO S•59 3M 3•'63 F.R.CO.